Menstrual and reproductive history and use of exogenous sex hormones and risk of thyroid cancer among women: a meta-analysis of prospective studies

Caini, Saverio; Gibelli, Bianca; Palli, Domenico; Saieva, Calogero; Ruscica, Massimiliano; Gandini, Sara

doi:10.1007/s10552-015-0546-z

Cited by 57 publications

(46 citation statements)

References 55 publications

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“…Similarly, a population-based case–control study carried out in the USA showed a transiently increased risk of PTC among women who had delivered a live birth within the 5 years before the reference date, and the risk was even more pronounced among women with two or more births (OR 4.2, 95% CI 2.0–8.9) compared to women with one pregnancy only (OR 1.6, 95% CI 1.0–2.7) (15). A short-term effect of pregnancy on thyroid cancer risk is also supported by pooled estimates of large datasets (32, 34, 52, 53) and findings from other studies (16–18, 27, 31, 54). However, other investigations concluded that ever being pregnant, number of births and/or recency of pregnancies resulted in no increased (23, 26) or even decreased (22) risk of DTC (Table 2).…”

Section: Resultssupporting

confidence: 55%

“…More recently, two meta-analyses showed postmenopausal status and older age at menopause to be, respectively, associated with a borderline significant reduction (RR 0.79, 95% CI 0.62–1.01) (32) and increase (RR 1.24, 95% CI 1.00–1.53) (33) of DTC risk. A further meta-analysis focusing on PTC only, also found late age at menopause to be associated with increased PTC risk (RR = 1.39, 95% CI 1.03–1.89) (34).…”

Section: Resultsmentioning

confidence: 99%

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Female Reproductive Factors and Differentiated Thyroid Cancer

et al. 2017

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Differentiated thyroid cancer (DTC) is markedly more common in women than men, the highest female-to-male ratio being recorded during the reproductive period. This evidence has led to the suggestion that female hormonal and reproductive factors may account for the observed DTC gender disparity. This review focuses on current evidence on the risk of DTC in conjunction with major female reproductive factors, including the impact of pregnancy on DTC occurrence and progression/recurrence. Overall, studies exploring the link between the risk of DTC and menstrual and menopausal factors, oral contraceptives and/or hormone replacement therapy, showed these associations, if any, to be generally weak. Nonetheless, there is some evidence that higher levels of exposure to estrogens during reproductive years may confer an increased risk of DTC. As far as pregnancy is concerned, it is unclear whether a potential association between parity and risk of DTC actually exists, and whether it is enhanced in the short-term following delivery. A possible role for pregnancy-related factors in DTC progression has been recently suggested by some reports, the results of which are consistent with a worse outcome in the short-term of women diagnosed with DTC during gestation compared to non-pregnant control patients. Also, some progression of disease has been described in women with structural evidence of disease prior to pregnancy. However, there seems to be no impact from pregnancy in DTC-related death or overall survival. Several in vitro and animal studies have evaluated the influence of estrogens (E) and estrogen receptors (ERs) on thyroid cell proliferation. Presently available data are indicative of a role of E and ERs in thyroid cancer growth, although considerable discrepancies in respect to ER expression patterns in thyroid cancer tissues actually exist. Further studies providing more direct evidence on the possible role of E and of placental hormones and growth factors on thyroid growth may expand our knowledge on the mechanisms beyond the gender disparity of proliferative thyroid diseases.

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Section: Resultssupporting

confidence: 55%

Section: Resultsmentioning

confidence: 99%

Female Reproductive Factors and Differentiated Thyroid Cancer

et al. 2017

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“…The role of estrogens in the development and evolution of DTC has been widely analyzed in several studies [20,21,22,23,24,25,26,27,28]. A recent meta-analysis including >5,000 patients reported that menopausal women had a reduced thyroid cancer risk, whereas increasing age at first pregnancy/birth was associated with a higher cancer risk [29]. Similar to other epithelial tumors, DTC also expresses both ER isoforms, with ER-α activation being associated with increased estrogen-dependent cell proliferation and, in contrast, ER-β likely promoting apoptotic actions and other suppressive functions in thyroid tumors [22,30,31,32,33].…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical Expression of Estrogen Receptor-α and Progesterone Receptor in Patients with Papillary Thyroid Cancer

Sturniolo¹,

Zafón²,

Moleti³

et al. 2016

Eur Thyroid J

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Background: Papillary thyroid cancer (PTC) prevalence is nearly 3 times higher in females than in males. This gender difference suggests that growth and progression of PTC might be influenced by female sex hormones. Objectives: To analyze the expression of both estrogen receptor (ER)-α and progesterone receptor (PR) by immunohistochemistry in 203 PTC patients. Methods: ER-α and PR expression was evaluated in paraffin-embedded tumor tissue samples of 45 males and 158 females followed up for 7.2 ± 3.7 years. Results: ER-α was expressed in 52 (25.6%) patients (41 females and 11 males) and PR in 94 (46.3%) patients (75 females and 19 males). ER-α and PR were coexpressed in 31 (15.3%) patients (27 females and 4 males). ER-α expression correlated significantly with tumor size in the whole sample (ER-α positive 22.8 ± 11.8 mm vs. ER-α negative 15.1 ± 12.4 mm; p = 0.02) and in the subgroup of women (ER-α positive 18.8 ± 12.8 mm vs. ER-α negative 14.9 ± 12.3 mm; p = 0.048). In addition, ER-α expression significantly correlated with remission of the disease. In fact, of the 192 patients followed up, 50/153 (32.7%) disease-free patients were ER-α positive, in contrast to only 3/39 (7.7%) with evidence of disease persistence/recurrence (χ² = 8.5, p = 0.0036). PR expression was not associated with any of the parameters analyzed. Conclusions: The present study confirmed recent data indicating that ER-α and PR expression is a common finding in thyroid tumor tissue. However, in contrast to previous reports, we observed an association between ER-α expression and a more favorable outcome in PTC patients.

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“…Based on epidemiological data, it has long been proposed that hormonal factors may determine or modulate the risk of thyroid cancer. Indeed, thyroid cancers are threefold more frequent in women than in men after puberty and incidence decreases after menopause . A role of female hormones in the aetiology of thyroid cancer has been suggested with a direct action of oestrogens, via its receptors (ER), on proliferative and neoplastic disorders .…”

Section: Introductionmentioning

confidence: 99%

Relation between hysterectomy, oophorectomy and the risk of incident differentiated thyroid cancer: The E3N cohort

Guenego

Mesrine

Dartois

et al. 2018

Clinical Endocrinology

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Summary Background Thyroid cancers are threefold more frequent in women than in men. A role of reproductive or hormonal factors has been suggested but with contradictory results. We investigated potential associations between history of hysterectomy, with or without oophorectomy, and history of benign gynaecological disease (uterine fibroids, endometriosis) and the incidence of differentiated thyroid cancer, in a large French prospective cohort. Methods A total of 89 340 women from the E3N cohort were followed up between 1990 and 2012. Gynaecological diseases treated by surgery were self‐reported. Thyroid cancers were validated by histological reports. Time‐dependent covariates included smoking status, BMI and history of benign thyroid disease. Cox proportional hazard models with age as timescale were used to estimate Hazard Ratios (HR) and 95% confidence intervals (CI). Results A total of 412 cases of thyroid cancer were diagnosed during follow‐up. A history of hysterectomy was associated with an increased risk of differentiated thyroid cancer (adjusted HR=2.05; 95%CI: 1.65‐2.55). The association was not altered after further adjustment for reproductive factors. Endometriosis, uterine polyps, ovarian cysts and oophorectomy without hysterectomy were not associated with the risk of thyroid cancer. A history of fibroids was also significantly related to the risk of thyroid cancer over the follow‐up period (adjusted HR=1.91; 95%CI: 1.50‐2.44) and the increased risk persisted after adjustment for history of hysterectomy. Conclusions Women who had either a history of fibroids or hysterectomy had an increased risk of differentiated thyroid cancer. These findings suggest shared biological mechanisms between fibroids and thyroid cancer, which deserve to be further dissected.

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Menstrual and reproductive history and use of exogenous sex hormones and risk of thyroid cancer among women: a meta-analysis of prospective studies

Abstract: Menstrual and reproductive factors may play a role in the etiology of thyroid cancer, possibly through the mediation of estrogen receptors.

Cited by 57 publications

References 55 publications

Female Reproductive Factors and Differentiated Thyroid Cancer

Female Reproductive Factors and Differentiated Thyroid Cancer

Immunohistochemical Expression of Estrogen Receptor-α and Progesterone Receptor in Patients with Papillary Thyroid Cancer

Relation between hysterectomy, oophorectomy and the risk of incident differentiated thyroid cancer: The E3N cohort

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